Analysis: fears have been raised once again about hospitals and ICUs becoming overwhelmed with Covid patients

As we experience the fourth wave of the Covid-19 pandemic, fears have been raised once again about our hospitals, and particularly our intensive care units (ICUs), becoming overwhelmed with patients suffering from the virus. As this is one of the metrics used by the National Public Health Emergency Team (NPHET) to determine its advice to Government regarding public health measures, we have good reason to focus on it.

The number of people becoming infected with Covid-19 in Ireland in the fourth wave is higher than at any point other than the third wave in January and February of this year. Meanwhile, the number of people requiring hospitalisation, and the number in ICUs, are both significantly lower than they were during the third wave.

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From RTÉ Radio 1's Morning Ireland, ICU consultant Dr Andrew Westbrook on the Covid pressure on ICU capacity in Irish hospitals

Worryingly, though, both of the latter are rising. According to the official figures, there were 684 confirmed cases of Covid-19 in hospitals on November 21st. This compares with a peak of 2,020 on January 18th last and 881 at the peak of the first wave on April 15th 2020. In terms of intensive care, there were 125 Covid-19 confirmed patients in ICUs on November 21st, compared with the peak of 221 on January 24th and a localised peak of 155 on April 11th 2020, during the first wave.

The positive to these figures is that, compared with the third wave, a lower proportion of those who are being diagnosed with Covid-19 are ending up in hospital. But the downside is that a higher proportion of those who are in hospital are requiring ICU treatment.

We should not forget that ICU care is required by other seriously ill patients and not just those with Covid-19. Currently, nearly 40% of our ICU bed capacity is being taken up with Covid patients, leaving fewer ICU beds for those with other conditions.

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From RTÉ Radio 1's Saturday with Katie Hannon, can our hospital capacity cope if there is a Covid spike over winter?

More recently, we have seen elective procedures being postponed in order to free up capacity in our hospitals to deal with the fallout from the fourth wave. In this context, it is worth remembering that our waiting times are already the worst in Europe. Recent research from the ESRI suggests that the actual length of time for which people are awaiting treatment is longer than the official figures portray, given that they measure the length of time for which someone has been waiting rather than the total waiting time until treatment.

For some time, Ireland has lagged international levels of hospital bed capacity. The latest OECD figures show that, in 2019, we had 2.9 beds per 1,000 population, compared with an OECD average of 4.4. Notwithstanding the fact that the international figure has decreased in the last decade, that still puts us below the average. Not surprisingly therefore, we have one of the highest bed occupancy rates in the OECD, at 90.7%, second only to Canada, compared with an OECD average of 76.2% and a widely accepted safe rate of around 85%. That said, our bed occupancy rate decreased from over 95% in 2009, so at least we are moving in the right direction.

In terms of ICU beds, we are also below the average, with 5.2 adult intensive care beds per 100,000 population in 2019, compared with an OECD average of 14.1. However, there are some data comparability issues with these figures. Ireland is one of just three countries (along with England and Latvia) which only count critical care beds (Levels 2 and 3 of intensity), whereas most other countries also count Level 1 beds, while some other countries also include neonatal and paediatric ICU beds in their figures. With the surge capacity in 2020, we had a maximum of 7.1 ICU beds per 100,000 population last year, still below the average but an improvement on the 2019 figure.

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From RTÉ Radio 1's Morning Ireland, report on Covid's effect on other areas of healthcare especially transplants

Budget 2022 allocated an extra €10.5m to provide an additional 19 ICU beds, which would bring the total to 340 (a 6% increase). The Department of Health noted that over 800 acute hospital beds were added to the system since the onset of the pandemic (Budget 2021 made a significant allocation to increase capacity in the health system), with a continued expansion of capacity expected next year.

This is in the context of a significant expansion of hospital and non-hospital capacity envisaged under the Sláintecare plan, albeit this plan is not running as smoothly as had been hoped. Despite this, ESRI research suggests that even the planned additional 2,600 hospital beds might not be enough to cater for the increased demand arising from demographic pressures.

Besides additional bed capacity, extra staff will also be needed to provide care to the increased number of patients. However, we are seeking to significantly expand our medical workforce in an increasingly competitive international market, in which significant shortages of doctors and nurses are forecast across the OECD. Meanwhile, in the short-term, thousands of health workers are absent from work with Covid or as close contacts.

Ireland is not the only European country with concerns about hospital and ICU capacity to deal with the pandemic and other demands on the system

It should be noted that Ireland is not the only European country with concerns about hospital and particularly ICU capacity to deal with the pandemic as well as the other demands on the system. We have, however, started from a lower base than most, although our higher vaccination rate means that fewer people are ending up with severe illness.

The pandemic has highlighted the need to increase capacity, and steps have been made to do this since its onset. However, these steps need to continue apace, and our capacity increased for the longer-term. If that happens, then it may just be a silver lining.


The views expressed here are those of the author and do not represent or reflect the views of RTÉ